Web 2.0 technologies for undergraduate and postgraduate medical education: an online survey

1. 759
ORIGINAL ARTICLE
Web 2.0 technologies for undergraduate and postgraduate
medical education: an online survey
J Sandars, S Schroter
...................................................................................................................................
Postgrad Med J 2007;83:759–762. doi: 10.1136/pgmj.2007.063123
Objectives: To identify the current familiarity and use of Web 2.0 technologies by medical students and
qualified medical practitioners, and to identify the barriers to its use for medical education.
See end of article for Methods: A semi-structured online questionnaire survey of 3000 medical students and 3000 qualified
authors’ affiliations medical practitioners (consultants, general practitioners and doctors in training) on the British Medical
........................
Association’s membership database.
Correspondence to: Results: All groups had high familiarity, but low use, of podcasts. Ownership of digital media players was
Dr John Sandars, Medical higher among medical students. There was high familiarity, but low use, of other Web 2.0 technologies
Education Unit, The
University of Leeds, 20 Hyde except for high use of instant messaging and social networking by medical students. All groups stated that
Terrace, Leeds LS2 9LN, UK; they were interested in using Web 2.0 technologies for education but there was lack of knowledge and skills
j.e.sandars@leeds.ac.uk in how to use these new technologies.
Conclusions: There is an overall high awareness of a range of new Web 2.0 technologies by both medical
Received 16 July 2007
Accepted 19 September
students and qualified medical practitioners and high interest in its use for medical education. However, the
2007 potential of Web 2.0 technologies for undergraduate and postgraduate medical education will only be
........................ achieved if there is increased training in how to use this new approach.
A
wide range of Web 2.0 technologies have become very general type of technology, only a particular product. Questions
popular within the general population. For example, about the use of Web 2.0 technologies included any context,
there are over 90 million blogs and the My Space social including social and educational. Free text responses were
networking site has over 106 million users.1 The main types of invited to identify the factors that may influence the uptake of
Web 2.0 technologies are described in box 1. these new technologies for education. These free text responses
A major reason for this uptake has been that they require were analysed independently by the two researchers using a
little or no technical expertise, allowing users to easily create grounded theory approach to identify the main themes.5 For
their own content and also to actively share information, each theme an illustrative quotation was noted. The two sets of
opinion and support across networks of users.2 Most of this themes were compared and discussed between the authors
activity is social but the educational potential is increasingly until consensus was reached. Descriptive quantitative data were
being recognised.3 For example, podcasts can deliver educa- analysed using SPSS.
tional materials in addition to popular music and blogs can be
used as reflective diaries and to develop online communities of RESULTS
practice. Of the 6000 questionnaires sent, 111 were email delivery
The potential of Web 2.0 technologies for undergraduate and failures. We received a response from 1239 (21%) of the 5889
postgraduate medical education has been recognised but there functioning email addresses (637 medical students and 601
has been little implementation.4 Further development in this qualified doctors). There was no significant difference in the
area will require an understanding of how this group currently mean age of the respondents and non-respondents for medical
uses Web 2.0 technologies and the barriers to effective use. students (p,0.00) or qualified doctors (p = 0.01).
The objectives of this survey were to identify the current A total of 593 (48%) of the respondents identified themselves
familiarity and use of Web 2.0 technologies by medical students as medical students, 389 (31%) as consultants, 96 (8%) as
and qualified medical practitioners, and to identify the barriers general practitioners and 64 (5%) as doctors in training. Table 1
to its use for medical education. shows the sample characteristics.
Half of the consultants, general practitioners and doctors in
METHODS training owned an MP3 or digital media player, but over three
From the 18 625 people listed on the British Medical quarters of medical students were owners (table 2). Players
Association’s membership database as receiving the Student capable of playing videos were similar across all groups.
BMJ in July 2006, a computer generated random sample of 3000 Most respondents were familiar with the term podcast and
medical students was taken. A computer generated random approximately half of each group had used them, mainly for
sample of 3000 doctors was taken from the 106 099 qualified personal use (table 3). About 60% of respondents in all groups
doctors (consultants, general practitioners and doctors in stated that podcasts were of no use in professional development
training) listed on the database as receiving the BMJ in July but about 10% regarded them as being very or extremely useful
2006. (table 4).
Participants were sent an email in February 2007 inviting Most consultants, general practitioners and doctors in
them to complete an online semi-structured questionnaire that training were familiar with the terms instant messaging and
had been piloted and refined by a group who were not involved blogs, but less so for other types of Web 2.0 technologies
in this study. Examples of the technologies were given since we (table 5). Medical students were more familiar with all of the
were concerned that participants may not be aware of the terms, especially instant messaging, blogs and social networking.
www.postgradmedj.com

2. 760 Sandars, Schroter
Box 1: Main types of Web 2.0 technologies Table 1 Age and sex distribution of sample
General Doctors in Medical
N Podcasting: A digital recording, or podcast, is produced Consultant
n = 389
practitioner
n = 96
training
n = 64
Student
n = 593
and then played on a digital media player. The digital
recording is commonly in the form of an audio MP3 Male 255 (66.0%) 38 (39.6%) 37 (57.8%) 237 (40.0%)
Female 134 (34.0%) 58 (60.4%) 27 (42.2%) 356 (60.0%)
(MPEG-1 Audio Layer 3) file but it may also include other Mean (SD) age 48.3 (8.3) 42.3 (11.1) 37.8 (10.7) 24.4 (5.5)
formats, including video. The downloaded digital media (years)
files can be played on a range of devices. These include a
personal computer (PC) or laptop which has a media
player, such as iTunes or Windows Media Player,
installed. They can also be played on a wide range of ‘‘I would consider using some of these if I only knew how’’—
portable devices which support the file format, including 46-year-old female consultant (ID 5240)
iPods, MP3 players of many different brands, an ‘‘Need to be taught how to use these technologies’’—41-
increasing number of mobile phones, and Portable year-old female general practitioner (ID3405)
Digital Assistants (PDAs). ‘‘We should be shown how to use new media’’—22-year-
N Instant messaging: This allows real time (synchronous) old male medical student (ID 341)
communication between two individuals (one to one) or
between several individuals (one to many). Examples of Medical students were the main group (13) who specifically
commonly used text based services include MSN commented on the potential use of podcasts for their
messenger (www.msn.com) and Yahoo! Messenger professional education:
(www.yahoo.com).
N Blogs: These are personal websites that allow rapid ‘‘I find podcasts can be very useful as you can listen along
updating by the author. Examples include Blogger when travelling. They are currently in short supply’’—23-
(www.blogger.com) and Typepad (www.typepad.com). year-old female medical student (ID 1736)
Content can be easily created and shared by making the
blog accessible to others.
N Wikis: These are similar to blogs but allow the text on the 2. Barriers due to learning and technology preferences
website to be edited by others, with the creation of a Nineteen respondents from all groups except doctors in training
common document that can be shared between indivi- stated that a main barrier to using Web 2.0 technologies for
duals. Examples include Wikipedia (www.wikipedia.org) professional education was their learning preferences and
and PB wiki (www.pbwiki.com). dislike for technology:
N Social bookmarking: An individual’s favourite websites,
‘‘Haven’t got out of the habit of sitting on the sofa with a
including blogs, can be ‘‘book marked’’ and stored on a
website. Examples include del.icio.us (http://del.icio.us/) book or journal’’—47-year-old female consultant (ID 4250)
and digg (www.digg.com). These bookmarks can be ‘‘I much prefer face to face discussion’’—56-year-old male
shared with others. general practitioner (ID 4623)
N Media sharing: Visual media can be uploaded and ‘‘Generally speaking I don’t like too much technology in my
education’’—24-year-old male medical student (ID 208)
stored on a website, such as Flickr (www.flickr.com) for
photographs and You Tube (www.youtube.com) for
videos. These media can then be shared with others.
3. Quality of resources
N Social networking sites: Several of the above
Concern about the quality of the resources was stated by 15
approaches can be combined in these sites to make
respondents from consultants, medical students and doctors in
them extremely versatile. Examples include My Space
training:
(www.myspace.com) and Facebook (www.facebook.
com).
‘‘I am not confident in the accuracy of the information given
in some areas’’—41-year-old male consultant (ID 4560)
‘‘Quality of information is always very important’’—32-
All groups used Web 2.0 technologies for either personal or year-old doctor in training (ID 1997)
educational use and this was higher than their stated familiarity. ‘‘Publicise who writes/publishes the content more clearly’’—
Medical students had the highest use of instant messaging, media 23-year-old female medical student (ID 933)
sharing and social networking.
Free text comments were made by 60 consultants, nine
general practitioners, eight doctors in training, and 42 medical 4. Organisational issues
students. Four main themes were identified. Seven consultants and general practitioners expressed concern
about having time to use Web 2.0 technologies for professional
education, and eight consultants noted difficulties with access
1. Interested in use but need of further training to information and communication technology (ICT) at work.
Fifty-seven respondents from all groups except doctors in
training stated that they were interested in using Web 2.0
technologies for their professional education but most (54) ‘‘I have no idea how anyone can have the time if they are
additionally commented on the need for greater training in how working hard’’—51-year-old male consultant (ID 4640)
to use the new technologies to enhance their professional ‘‘Lack of time is a huge factor’’—48-year-old male general
education: practitioner (ID 3623)
www.postgradmedj.com

3. Web 2.0 technologies for medical education 761
Table 2 Ownership of MP3/digital media players
General Doctors in
Consultant practitioner training Medical student
n = 389 (%) n = 96 (%) n = 64 (%) n = 593 (%)
Ownership of MP3/digital media player 190 (48.8) 45 (46.9) 35 (54.7) 473 (79.8)
Ownership of MP3/digital media player 75 (19.3) 17 (17.7) 13 (20.3) 145 (24.5)
that can play video
Table 3 Use of podcasts
General Doctors in
Consultant practitioner training Medical student
n = 389 (%) n = 96 (%) n = 64 (%) n = 593 (%)
Podcasts—not familiar with term 19 (4.9) 5 (5.2) 5 (7.8) 13 (2.2)
Podcasts—never used 220 (56.6) 50 (52.1) 32 (50) 270 (45.5)
Podcasts—only for personal use 86 (22.1) 24 (25.0) 20 (31.3) 20 (33.9)
Podcasts—for both personal use and 50 (12.9) 15 (15.6) 4 (6.3) 93 (15.7)
professional learning
‘‘A major problem is the ease of access and connectivity to those under 24 years of age.9 10 It is essential for educators to use
these services in the workplace’’—40-year-old consultant (ID these Web 2.0 technologies if they wish to fully engage younger
4332) learners, usually as a blended approach.11 This offers technology as
an additional, but integrated, method to enhance learning. This
has important implications to all medical educators since they are
DISCUSSION likely to be older users of technology. We recommend that all
The survey has identified that overall for all groups there is high medical educators are trained on how to use Web 2.0 technologies
familiarity with Web 2.0 technologies for personal and to enhance teaching and learning.
educational purposes, but less actual use. Medical students Many respondents stated that they would appreciate training
have both greater familiarity and use of Web 2.0 technologies, in how to use Web 2.0 technologies for education but any
especially instant messaging, media sharing and social book- response requires careful consideration.12 There has been an
marking. There was interest in the use of Web 2.0 technologies evolving change in the operation of the web, with a transition
for education by all groups but respondents stated that they from a platform that previously only offered discrete packages
would like to have more training on its use. Other barriers for of information, such as websites, from a few providers to one in
use in education were learning preferences, concern about which there is a wide range of user generated material, such as
quality of resources, lack of time and difficulties with ICT blogs or podcasts, provided by a large variety of individuals and
access. organisations. The exciting potential for medical education is
A limitation of this study is that the survey was limited to the that a vast learning resource has suddenly become available.
BMA membership database and the majority of doctors were The ‘‘ecological’’ approach to e-learning describes a new type of
from the UK. The response rate was low and also there was education in which personalised learning can be created by
under-representation of general practitioners and doctors in assembling a wide range of learning resources that are of
training. The response rate is typical of all readership surveys specific interest to the learner.13 This requires new skills, such as
and the respondents are also likely to have higher levels of identification, storage and quality appraisal of resources. We
interest in the topic.6 recommend that all medical educators and learners are trained
We identified a ‘‘digital divide’’ between older and younger in these essential skills. The role of the educator changes to one
users of technology. This term was originally applied to that helps the learner to navigate the complexity of the new
inequalities in access to computer and web facilities,7 but learning landscape.
increasingly it is apparent that there are numerous inequalities.8 Inequalities in access to new technologies, due to both lack of
An important difference is the high use of instant messaging, time and computing facilities, was noted by consultants and
media sharing and social networking by young people, especially general practitioners. It will be essential to remedy these
Table 4 Usefulness of podcasts for assisting learning directly related to professional
development
General Medical
Consultant practitioner Doctors in training student
n = 292 (%) n = 66 (%) n = 64 (%) n = 510 (%)
Not at all useful 163 (56) 39 (59) 38 (70) 299 (59)
Slightly or moderately useful 87 (30) 17 (26) 13 (24) 122 (24)
Very or extremely useful 23 (8) 4 (6) 2 (4) 72 (14)
Respondents were asked to rate the usefulness of podcasts for assisting their learning directly related to their professional
development on a 5 point Likert scale. This table excludes respondents who indicated that they are not familiar with
podcasts.
www.postgradmedj.com

4. 762 Sandars, Schroter
Table 5 Familiarity and use of social software
Consultant General practitioner Doctors in training Medical student
n = 389 (%) n = 96 (%) n = 64 (%) n = 593 (%)
Instant messaging—not familiar with term 37 (9.5) 10 (10.4) 4 (6.3) 2 (0.3)
Instant messaging—never used 32.5 (83.5) 57 (59.4) 31 (48.4) 143 (24.0)
Blogs—not familiar with term 23 (5.9) 5 (5.2) 4 (6.3) 14 (2.4)
Blogs—never used 265 (68.1) 66 (68.8) 39 (60.9) 345 (58.2)
Blogs—only read 76 (19.5) 15 (15.6) 18 (28.1) 118 (19.9)
Blogs—both read and write 13 (3.3) 8 (8.3) 2 (3.1) 9.5 (16.0)
Wikis—not familiar with term 121 (31.1) 39 (40.6) 13 (20.3) 166 (28.0)
Wikis—never used 174 (44.7) 38 (49.6) 27 (42.2) 113 (19.1)
Social bookmarking—not familiar with term 144 (37.0) 41 (42.7) 20 (31.3) 187 (31.5)
Social bookmarking—never used 225 (57.8) 54 (56.3) 39 (60.9) 374 (63.1)
Media sharing—not familiar with term 133 (34.2) 37 (38.5) 20 (31.3) 124 (20.9)
Media sharing—never used 238 (61.2) 54 (56.3) 35 (54.7) 376 (63.4)
Social networking—not familiar with term 61 (15.7) 18 (18.8) 9 (14.1) 9 (1.5)
Social networking—never used 242 (62.2) 59 (61.5) 33 (51.6) 114 (19.2)
.......................
Main findings Authors’ affiliations
J Sandars, Medical Education Unit, The University of Leeds, Leeds, UK
S Schroter, BMJ Editorial, BMA House, Tavistock Square, London, UK
N Overall there is high familiarity with Web 2.0 technologies
We received no additional funding for this study
for personal and educational purposes but less actual use.
N Medical students have greater familiarity and use of Web SS is employed as a researcher by the BMJ Publishing Group
2.0 technologies, especially instant messaging, media Ethics: This study was approved by the BMJ Publishing Group’s Research &
sharing and social bookmarking. Experimentation Group Funding
N There was interest in the use of Web 2.0 technologies for
education by all groups, but respondents stated that they REFERENCES
would like to have more training on its use. 1 Magid L, Collier A. My space – safe online networking for your kids, Pearson
N Other barriers for use in education were learning Prentice Hall Harlow, 2007.
2 O’Reilly T. What is Web 2.0. 2005. http://www.oreillynet.com/pub/a/oreilly/
preferences, concern about quality of resources, lack of tim/news/2005/09/30/what-is-web-20.html (Accessed 26 May 2007).
time and difficulties with information and communication 3 Balacheff N, Hardin J. Advances of the semantic web for e-learning: expanding
technology access. learning frontiers. Br J Educ Technol 2006;37:321–30.
4 Boulos MNK, Maramba I, Wheeler S. Wikis, blogs and podcasts: a new
generation of web-based tools for virtual collaborative clinical practice and
education. BMC Medical Education 2006;6:41–52.
5 Patton MQ. Qualitative evaluation and research methods, 2nd ed. Newbury
organisational issues before the potential of Web 2.0 technol- Park, California: Sage, 1990.
6 Brennan M. Techniques for improving mail survey response rates. Marketing
ogies in education can be realised.14 Bulletin 1992;3:24–37.
7 Tapscott D. Growing up digital: the rise of the net generation. New York:
McGraw-Hill, 1998.
Conclusion 8 Haythornthwaite C. The internet in everyday life. American Behavioural Scientist
Web 2.0 technologies offer new opportunities in undergraduate 2001;45:363–82.
and postgraduate medical education. There is an overall high 9 Kennedy G, Krause K-L, Judd T, et al. First year students’ experiences with
awareness of a range of new Web 2.0 technologies by both medical technology: are they really digital natives? Melbourne: Centre for Study of Higher
Education, The University of Melbourne, 2006.
students and qualified medical practitioners and high interest in 10 White D. Results of the ‘‘Online Tool Use Survey’’ undertaken by the JISC funded
its use for medical education. However, the potential of Web 2.0 SPIRE project. 2007. tallblog.conted.ox.ac.uk/wpcontent/
technologies for undergraduate and postgraduate medical educa- jisc_spire_surveyresults.pdf (accessed 26 May 2007).
11 Oblinger DG, Oblinger JL. Educating the net generation. Washington DC:
tion will only be achieved if there is increased training in how to EDUCAUSE, 2005.
use these technologies to enhance teaching and learning. 12 Dron J. Control and constraint in E-learning: choosing when to choose. Hershey
Pennsylvania: Idea Group Inc, 2007.
13 Sandars J, Haythornthwaite C. New horizons in medical education: ecological
ACKNOWLEDGEMENTS and Web 2.0 perspectives. Medical Teacher 2007;29:307–10.
We would like to thank all the respondents who completed the 14 Haney D. Assessing organizational readiness for E learning. Performance
questionnaire. Improvement 2002;41:216–21.
www.postgradmedj.com